Asparaginase-Associated Pancreatitis in Acute Lymphoblastic Leukemia : Results From the NOPHO ALL2008 Treatment of Patients 1-45 Years of Age

Show full item record



Permalink

http://hdl.handle.net/10138/311328

Citation

Rank , C U , Wolthers , B O , Grell , K , Albertsen , B K , Frandsen , T L , Overgaard , U M , Toft , N , Nielsen , O J , Wehner , P S , Harila-Saari , A , Heyman , M M , Malmros , J , Abrahamsson , J , Noren-Nystrom , U , Tomaszewska-Toporska , B , Lund , B , Jarvis , K B , Quist-Paulsen , P , Vaitkeviciene , G E , Griskevicius , L , Taskinen , M , Wartiovaara-Kautto , U , Lepik , K , Punab , M , Jonsson , O G & Schmiegelow , K 2020 , ' Asparaginase-Associated Pancreatitis in Acute Lymphoblastic Leukemia : Results From the NOPHO ALL2008 Treatment of Patients 1-45 Years of Age ' , Journal of Clinical Oncology , vol. 38 , no. 2 , pp. 145-+ . https://doi.org/10.1200/JCO.19.02208

Title: Asparaginase-Associated Pancreatitis in Acute Lymphoblastic Leukemia : Results From the NOPHO ALL2008 Treatment of Patients 1-45 Years of Age
Author: Rank, Cecilie U.; Wolthers, Benjamin O.; Grell, Kathrine; Albertsen, Birgitte K.; Frandsen, Thomas L.; Overgaard, Ulrik M.; Toft, Nina; Nielsen, Ove J.; Wehner, Peder S.; Harila-Saari, Arja; Heyman, Mats M.; Malmros, Johan; Abrahamsson, Jonas; Noren-Nystrom, Ulrika; Tomaszewska-Toporska, Beata; Lund, Bendik; Jarvis, Kirsten B.; Quist-Paulsen, Petter; Vaitkeviciene, Goda E.; Griskevicius, Laimonas; Taskinen, Mervi; Wartiovaara-Kautto, Ulla; Lepik, Kristi; Punab, Mari; Jonsson, Olafur G.; Schmiegelow, Kjeld
Contributor: University of Helsinki, HUS Comprehensive Cancer Center
University of Helsinki, HUS Comprehensive Cancer Center
Date: 2020-01-10
Language: eng
Number of pages: 11
Belongs to series: Journal of Clinical Oncology
ISSN: 0732-183X
URI: http://hdl.handle.net/10138/311328
Abstract: PURPOSE Asparaginase-associated pancreatitis (AAP) is common in patients with acute lymphoblastic leukemia (ALL), but risk differences across age groups both in relation to first-time AAP and after asparaginase re-exposure have not been explored. PATIENTS AND METHODS We prospectively registered AAP (n = 168) during treatment of 2,448 consecutive ALL patients aged 1.0-45.9 years diagnosed from July 2008 to October 2018 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. RESULTS Compared with patients aged 1.0-9.9 years, adjusted AAP hazard ratios (HRa) were associated with higher age with almost identical HRa (1.6; 95% CI, 1.1 to 2.3; P = .02) for adolescents (10.0-17.9 years) and adults (18.0-45.9 years). The day 280 cumulative incidences of AAP were 7.0% for children (1.0-9.9 years: 95% CI, 5.4 to 8.6), 10.1% for adolescents (10.0 to 17.9 years: 95% CI, 7.0 to 13.3), and 11.0% for adults (18.0-45.9 years: 95% CI, 7.1 to 14.9; P = .03). Adolescents had increased odds of both acute (odds ratio [OR], 5.2; 95% CI, 2.1 to 13.2; P = .0005) and persisting complications (OR, 6.7; 95% CI, 2.4 to 18.4; P = .0002) compared with children (1.0-9.9 years), whereas adults had increased odds of only persisting complications (OR, 4.1; 95% CI, 1.4 to 11.8; P = .01). Fifteen of 34 asparaginase-rechallenged patients developed a second AAP. Asparaginase was truncated in 17/21 patients with AAP who subsequently developed leukemic relapse, but neither AAP nor the asparaginase truncation was associated with increased risk of relapse. CONCLUSION Older children and adults had similar AAP risk, whereas morbidity was most pronounced among adolescents. Asparaginase re-exposure should be considered only for patients with an anticipated high risk of leukemic relapse, because multiple studies strongly indicate that reduction of asparaginase treatment intensity increases the risk of relapse. (C) 2019 by American Society of Clinical Oncology
Subject: FARBER-CANCER-INSTITUTE
COLI L-ASPARAGINASE
ERWINIA-ASPARAGINASE
STANDARD-RISK
YOUNG-ADULTS
CHILDREN
ADOLESCENTS
PROTOCOL
CLASSIFICATION
DEFINITIONS
3122 Cancers
Rights:


Files in this item

Total number of downloads: Loading...

Files Size Format View
jco.19.02208.pdf 704.2Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record